Individual
DR. STANTON TUCKER COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC, DACAN
Contact information
Practice address
1501 ROBERT J CONLAN BLVD NE, SUITE 3, PALM BAY, FL 32905-3502
(321) 726-8116
(321) 726-8535
Mailing address
1501 ROBERT J CONLAN BLVD NE, SUITE 3, PALM BAY, FL 32905-3502
(321) 726-8116
(321) 726-8535
Taxonomy
Speciality
Code
Description
License number
State
111NN0400X
Neurology Chiropractor
Primary
CH0003926
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
88902Z
MEDICARE
FL
Enumeration date
10/16/2006
Last updated
09/13/2007
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